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Adverse Childhood Experiences (ACE): How they Affect Health and Well-being

Adverse Childhood Experiences (ACE): How they Affect Health and Well-being

In past articles and our most recent article on trauma, we have mentioned the impact that Adverse Childhood Experiences, or ACEs, can have on an individual. While it wasn’t long ago that we figured it out, there is a great deal of research supporting the notion that one of the key contributing factors to substance abuse, mental health and other behavioral disorders is childhood trauma. Adverse Childhood Experiences, known widely as ACEs, are common and seemingly passive experiences that one may have as a child, that, when occurring repeatedly or in combination, have a devastating impact on a person’s development and long-term health.

When an Adverse Life Event takes place during one’s life in later adolescence or as an adult, the connection for the survivor to make between the traumatic experience and their future issues can be clear. Whether it’s a singular “Big T” trauma or a series of less severe “Little T” traumatic events, the link between these experiences and a person’s behaviors can often be made easily. For example, a 58-year-old man who recently went through a divorce, was laid off and then lost his house, might make the connection between these experiences and his increased drinking and isolation.

However, the link between ACEs and mental health or substance abuse issues that develop later in life can be more difficult, for a couple of reasons. For one thing, the mental health or substance abuse issues often don’t surface until years, or even decades, after the Adverse Childhood Experience occurs. What starts as general family dysfunction, divorce, neglect, or abuse may seem relatively normal through childhood and even into adulthood. The early signs and symptoms of a greater issue often manifest themselves as isolation, lack of trust, avoidance and other social and emotional issues before they ever develop into substance abuse or severe mental illness.

What are ACEs?

The notion of Adverse Childhood Experiences, or ACEs, began with the research of the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study. The study was conducted between 1995 and 1997 and studied nearly 17,000 Kaiser patients in a San Diego Health Clinic[1]. Patient health was studied through physical exams and surveys of current health and behaviors, while they also completed surveys about childhood experiences. What this groundbreaking study was looking at was the link – which was not understood at the time – between childhood trauma and physical, mental and emotional health later in life.

The ten childhood experiences they were looking at were:

Childhood abuse

1.     Emotional Abuse

2.     Physical Abuse

3.     Sexual Abuse

Childhood neglect

4.     Physical Neglect

5.     Emotional Neglect

Household challenges

Growing up in a household were there was:

6.     Substance abuse

7.     Mental Illness

8.     Violent Treatment of a mother or step-mother

9.     Parental Separation/divorce

10.  An incarcerated household member

 

Participants in the study were then given an ACE Score between 0 and 10, the total sum based on how many of the 10 types of adverse experiences they reported experiencing.

The Findings of the CDC-Kaiser ACE Study

The ACE Score, from 0 to 10, is used to assess cumulative childhood stress – now sometimes referred to as “Little T” trauma or by association with this study – a person’s “ACEs”. One of the clearest and most widely understood finding of the study was that Adverse Childhood Experiences (ACEs) are more common than one might think, or thought at the time. More than half (52%) of the participants from the original CDC-Kaiser study reported having at least one ACE, and more than 1 in 5 (20%) reported exposure to 3 or more ACEs, while another 6.2% reported 4 or more exposures[2].

The most prevalent of the categories of childhood exposure was substance abuse in the household (25.6%); the least prevalent exposure category was evidence of criminal behavior in the household (3.4%)[3]. Another finding was that the susceptibility of a person’s exposure to multiple ACE categories, as the relationship between single categories of exposure was significant. If someone reported any single category of exposure, the probability of exposure to any additional category ranged from 65%–93%; and then not surprisingly, the probability of more than two additional exposures ranged from 40%–74%[4].

The key finding of the study as it related to health outcomes, and which changed the way we understood childhood trauma, was that as one’s ACE Score increases, so does the risk for serious diseases and conditions, including:

  • Alcoholism and alcohol abuse
  • Illicit drug use
  • Depression and other mental health issues
  • Suicide attempts
  • Health-related quality of life
  • Smoking
  • Chronic disease
  • Heart and liver disease
  • Poor academic achievement
  • Poor work performance and financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • STDs and unintended pregnancies
  • Risk for sexual violence and intimate partner violence

The increased risk for these negative health outcomes and well-being are dramatic. Compared to someone with an ACE Score of 0, a person with an ACE Score of 4 or more is:

  • 18 times as likely to have attempted suicide
  • Twice as likely to have had two or more weeks of depressed mood in the past year
  • Nearly 5 times as likely to have ever used illicit drugs
  • More than 11 times as likely to have ever inject drugs
  • More than 5 times as likely to be an alcoholic

How are ACEs Linked to Health Issues?

There is a large and growing body of research about how childhood stress and trauma affect brain development, brain chemistry and, thus, the regulation of the body’s emotional, stress and fear response systems are impacted. Repeated stress and activation of these systems of the brain dramatically alter the formation of myelinated axons and the amygdala, the part of the brain that activates the autonomic nervous system (ANS) and releases hormones like adrenaline and cortisol into the body. If you’re walking through the woods and see a bear approaching, or you see a kid walking into oncoming traffic, the activation of this system is very effective in increasing your heart rate, opening your airways, and increasing blood flow to your organs and muscles, and away from certain parts of the brain.

However, if the stress response system is activated every night by the sound of your dad coming home, or the sight of your mom reaching for a bottle of alcohol, your body and brain are hit with the same fight-flight-freeze response. The repeated activation of this system take a toll on your vital organs as well as your brain’s ability to regulate emotions and responses to triggers. When the body produces too much of, or stops producing, the natural chemicals to sooth or excite you, it is very common for people to turn to external stimuli to compensate this: depressants like alcohol and benzodiazepines, stimulants like cocaine and methamphetamine, or even behaviors like gambling and sexual intercourse.

Exposure to abuse and neglect also impact the prefrontal cortex, the part of the brain responsible for high level cognition and controlling impulse, and the nucleus accumbens, the brain’s pleasure-reward center which releases the body’s natural dopamine. The nucleus accumbens was first discovered in 1954 by two scientists when rats became addicted to pressing a lever that activated this part of the brain. The role of the nucleus accumbens and its connection to the amygdala and hippocampus[5] have great implications in the study of psychiatric disorders, substance abuse and addiction, obsessive compulsive disorder and Tourette’s Syndrome, and more studies are being conducted.

Dose-Response Relationship

The CDC-Kaiser study also found a “dose-response” relationship between ACEs and negative health and well-being outcomes across a person’s lifetime. A dose-response relationship is one where as the dose or intensity of the trigger increases, so does the intensity of the maladaptive behavior or response. For example, the more a person is exposed to abuse or neglect, the more severe the negative health outcomes will be.

Follow-Up Studies

Dr. Nadine Burke-Harris

One of the most notable cases of these results in action was the work of Dr. Nadine Burke-Harris, a pediatrician in San Francisco who was originally unaware of the CDC-Kaiser ACE Study. She noticed when she began working in a hospital in Bayview-Hunter’s Point, a low-income area of the city riddled with addiction and violence, that there was an abnormal number of children being referred to her for Attention Deficit Hyperactivity Disorder (ADHD). One of her colleagues made her aware of the ACE Study, which led her down a path of studying her patients’ exposure to trauma and how the brain and body were impacting their health. She subsequently started the San Francisco Center for Youth Wellness, where Dr. Burke-Harris made it routine to screen children for their ACE Score to better understand the risk factors of these youth across their lifetime.

See her TED Talk on How Childhood Trauma Affects Health Across a Lifetime:

Behavioral Risk Factor Surveillance System (BRFSS)

In 2009, the CDC began collecting annual ACE data through the Behavioral Risk Factor Surveillance System (BFRSS) from voluntary respondents telephonically. It is now the longest-running phone survey in the world. The BFRSS asks questions modified from the original ACE Study, from people across 32 states, using randomly dialed numbers. The data collected from the BRFSS are:

All ACE questions refer to the respondent’s first 18 years of life.

  • Abuse1
    • Emotional abuse: A parent or other adult in your home ever swore at you, insulted you, or put you down.
    • Physical abuse: A parent or other adult in your home ever hit, beat, kicked or physically hurt you.
    • Sexual abuse: An adult or person at least 5 years older ever touched you in a sexual way, or tried to make you touch their body in a sexual way, or attempted to have sex with you.
  • Household Challenges
    • Intimate partner violence:2 Parents or adults in home ever slapped, hit, kicked, punched or beat each other up.
    • Household substance abuse: A household member was a problem drinker or alcoholic or used street drugs or abused prescription medications.
    • Household mental illness: A household member was depressed or mentally ill or a household member attempted suicide.
    • Parental separation or divorce: Parents were ever separated or divorced.
    • Incarcerated household member: A household member went to prison.

The findings of the BFRSS are similar to that of the original CDC-Kaiser ACE Study:

  • More than two-thirds of the participants reported at least one adverse childhood experience
  • More than 1 in 5 reported exposure to 3 or more ACEs

Similarly, they also found a dose-response relationship with ACE Scores correlated to an increase in the following:

  • Myocardial infarction
  • Asthma
  • Mental distress
  • Depression
  • Smoking
  • Disability
  • Reported income
  • Unemployment
  • Lowered educational attainment
  • Coronary heart disease
  • Stroke
  • Diabetes

Treatment of Childhood Trauma

Understanding the role that adverse childhood experiences (ACEs) play in brain development and prevalence of addiction, mental illness and life-threatening diseases is a pivotal precursor to addressing these issues. Identifying and acknowledging the root of the issues is an important step in the recovery process, and only once a person can work through the lasting effects of exposure to Adverse Childhood Experiences can they truly recover. Because of the way these experiences embed themselves in our brain and body, the process of resolving them can take months or even years, but even the most complex trauma can be resolved with enough time and commitment.

Despite the acceptance of this research in the medical field, behavioral health professionals have been slower to integrate the identification and treatment of trauma into practice. It is important for someone who has been exposed to these adverse childhood experiences to find help at trauma-focused treatment programs like Roots Through Recovery, who utilize evidence-based approaches like Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing (SE), Mindfulness-Based Stress Reduction (MBSR), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and expressive approaches like music and sound therapy, trauma-focused yoga, and art therapy.

EMDR at Roots Through Recovery

Resources:

[1] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[2] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[3] Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[4] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[5] https://www.eurekalert.org/pub_releases/2014-05/cafn-itp052114.php

Trauma: Big T and Little T

Trauma: Big T and Little T

The word “trauma” is used widely today to refer to an experience that is damaging to a person’s psychological health, and as we’ve mentioned in previous articles, the magnitude of this experience is completely dependent on the individual. What most people outside of the behavioral health profession don’t know is that trauma can be categorized into two classifications: what are known as “Big T” and “Little T.”

BIG T TRAUMA

In general, the Big T variation of trauma refers to a single, traumatic event that can leave a survivor of the event with symptoms associated with Post Traumatic Stress Disorder, or PTSD. Experiences like sexual assault, serious injuries, violent attacks, and near-death experiences all fall under this category, and it’s now widely understood what kind of impact Big T trauma can have on a person’s life. People coping with the effects of a traumatic event, and may be suffering from PTSD, experience various symptoms including:

Re-experiencing
  • Flashbacks
  • Bad dreams
  • Frightening thoughts
Avoidance
  • Staying away from places, events, or objects that are reminders of the experience
  • Avoiding thoughts or feelings related to the traumatic event
Arousal and reactivity
  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping, and/or having angry outbursts
Cognition and mood
  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Adapted from National Institute of Mental Health (NIMH)

POST TRAUMATIC STRESS DISORDER (PTSD)

Given the general public knowledge of trauma, you might find it surprising that it wasn’t until 1980 that the American Psychiatric Association recognized PTSD as a clinical diagnosis, when they added it to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). According to the U.S. Department of Veterans Affairs, the diagnosis was both controversial and groundbreaking as it suggested for the first time that the cause, “was outside the individual (i.e., a traumatic event) rather than an inherent individual weakness (i.e., a traumatic neurosis)”. The introduction, research and development of the PTSD diagnosis has paved the way for more trauma-informed and trauma-focused care. You can read the latest criteria for diagnosing PTSD in the DSM-V below.

LITTLE T TRAUMA

Little T trauma is a very different thing though, because it includes virtually every other adverse life experience — each hardship and struggle that people deal with throughout life — that doesn’t fall under the Big T umbrella. Whether it’s a case of bullying, loss of friends or family members, or an emotionally abusive relationship, Little T trauma tends to be the tough situations that many people deal with on a daily basis that don’t necessarily result in a clear diagnosis of a lasting effect. Because trauma is subjective and depends entirely on a person’s resilience and perception, adverse life experiences include anything that could potentially result in trauma; not only the presence of a negative experience, but also the absence of a positive one.

Trauma is anything short of love.

-Unknown

Everyone handles trauma (in either variety) in different ways, and there is now a fairly prevalent belief — and the scientific backing to prove — that dealing with repeated Little T trauma can be just as significant as a single occurrence of its Big T counterpart. Much like experiencing a traumatic life event such as a natural disaster or surviving a serious car crash, experiencing repeated events that engage the body’s stress response system can alter the neural network, especially when these experiences take place in early childhood.

ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY

Thanks to a study conducted by the CDC and Kaiser Permanente Health in the late 90s, we now know the impact the Adverse Childhood Experiences, or ACEs, have on a person’s neurodevelopment and social-emotional-cognitive development, and as a result, their later in life health outcomes. In the ACE Study, seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned.

What the study found was that a person with a higher ACE score was at significantly higher risk for substance abuse, mental health issues, intimate partner violence, and a host of health issues. Before the study was conducted and accepted by the medical and behavioral health community, these experiences that know refer to as adverse life events, adverse childhood experiences or Little T trauma, had been considered a normal part of life. Much like combat veterans returning home from war and being shamed or dismissed as being weak are now being treated for PTSD, these seemingly common but potentially damaging experiences are starting to garner the attention, empathy, or treatment that a Big T survivor might receive.

WHY ARE THESE IMPORTANT?

As mentioned above and in previous articles, exposure to trauma — whether it be Little T or Big T — can cause psychological (and sometimes physical) pain that often leads to destructive coping mechanisms, behavioral adaptations and health-risk behaviors. As a means to escape or numb the pain endured during the trauma, and the recurring discomfort that follows, survivors often turn to self-medicating with controlled substances. As with many addictions, it then becomes a vicious cycle that is generally only broken through proper trauma-focused treatment.

In all likelihood, every person will deal with some type of Little T trauma in their lifetime, and many will be no worse for the wear. But now that it has become recognized as a legitimate cause of maladaptive behaviors that can lead to mental health and substance use disorders, it can finally be treated and viewed on an even playing field with its “bigger” sibling.

Resources:

https://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract

https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html

https://www.sciencedirect.com/science/article/pii/S2352289516300273

https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml#pub3

https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp

 

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For more information or to start admissions – fill out the form below and we’ll reach out to you as soon as possible:

Health Net: 5 Things to Know About Your New Covered California Plan

Health Net: 5 Things to Know About Your New Covered California Plan

If you’re one of the million-plus people who get their Health Net insurance through Covered California, then you’ve hopefully just recently enrolled in coverage for the new year. Whether it’s your first time with subsidized healthcare or you’re a seasoned veteran, every year can bring new complications and changes to what you may have thought you understood. Thankfully, we’ve put together this quick checklist of steps to demystify your new Health Net insurance plan.

Check your new provider and plan

Just because you picked up Health Net insurance through the same portal doesn’t mean you have the same insurance coverage you did in previous years. Even if you were pretty thorough when looking at what you were choosing initially, you probably still want to actually check which insurance provider you now have and what’s covered under your current Health Net plan. Networks change for providers all the time — for instance, Roots Through Recovery is now in Health Net’s network — so you may have some new possibilities even if your provider hasn’t changed.

Look into new options

No matter if you’re looking at a brand new insurance plan or just a shift in the same one you’ve always had, there may be new medical providers and options for you that you weren’t aware of. Whether it’s simply finding a new doctor, accessing your substance abuse or mental health benefits, or looking into a whole different approach to your health, many insurance providers offer a wide and constantly changing variety of choices. If you’re not looking for a particular treatment right now, you may as well see what options you have available to you all year.

Understand the financial requirements

Beyond the amount you pay for the insurance each month, different plans have different out-of-pocket costs when actually seeking medical and behavioral health treatment. From co-pays to prescriptions to specialty services, just having health insurance doesn’t necessarily make your healthcare free. As a general rule of thumb, checking with the doctor, facility, or service provider can get you pretty close to the exact cost that’ll be incurred for various treatments — and they can also sometimes help you work with certain financial restrictions.

Keep track of your income changes

Although getting a new job and making significantly more money can drive your health insurance costs up through Covered California, misreporting or incorrectly estimating your income can also lead you to pay more than you should be. The point of Covered California is to make sure people pay an appropriate amount for health insurance, so keeping your income and tax situation up to date ensures that you don’t overpay if you lose your job or go through other dramatic life changes.

Schedule introductory consultations

Getting signed up for health insurance is the first step in making sure you’re all covered for the year. Before you actually need to seek treatment for the first time, you’ll need to figure out which in-network providers are the best for you. The easiest way to do this is simply by calling and scheduling consultations and introductory sessions with each provider you think you’ll need over the course of the year. Whether that means getting in contact with a facility like Roots Through Recovery or simply getting a check-up to add yourself to your new primary care physician’s patient list, getting in with the appropriate services and providers is ultimately the real reason to purchase healthcare.

If you’d like to check your benefits to see what’s covered under your new plan, you can verify your benefits here.

 

WE ARE HERE TO HELP YOU

For immediate assistance, please call our Admissions Specialists at +1(562) 473-0827 or +1(866) 766-8776.

For more information or to start admissions – fill out the form below and we’ll reach out to you as soon as possible:

Staff Spotlight: Meet Sam Weiss, LCSW

Staff Spotlight: Meet Sam Weiss, LCSW

Although Sam Weiss may be one of Roots Through Recovery’s newest Licensed Clinical Social Workers, she’s no rookie when it comes to working with the recovery community. Now that she’s completed the licensing process, Weiss can spend her days focusing on her professional passions of handling the initial assessments when new clients come in as well as her individual and group therapy sessions. With big dreams of one day opening up her own practice in order to help as many people as she can within the community, Weiss is keen to continue learning as much as possible in the coming years while staying true to her life’s mission of lending a helping hand to anyone who needs it.

What was it like to complete the process to become a Licensed Clinical Social Worker?
I just got licensed in October, and it was a 3-year long process, so it was very rewarding to finally be able to go and take the licensure test and pass the first time. It’s allowed me to work under my own license and have the opportunity to do more of my own things to help the clients.

What made you want to get into the field of social work within the recovery community?
My first introduction into the recovery community was not actually my choice. I was assigned to work in a mental health hospital and was placed in the dual diagnosis unit during my first internship experience while in undergrad. I worked there before I even knew I wanted to pursue social work. I really liked working with the population just because of the challenge and stigma attached to the population and how underserved they are. I eventually chose social work because of the breadth of the career. You can work one-on-one with people, but if I eventually decided that I wanted to work on an organizational or macro level, that’s something that I’d also be able to do. I like having that flexibility. Working in recovery is extremely rewarding, and I’m glad I was initially introduced to the recovery community early on in my schooling because I’ve fallen in love with the population.

How is Roots Through Recovery different than the other facilities you’ve worked at?
I love Roots. The facility where I was before looked at clients and staff as a number, so it was very hard to be able to do what I wanted with the clients because I had such an overloaded case load. Here at Roots, you can really tell how much they care about their clients and staff. It creates a really secure environment, and the feedback that we get from clients all the time is how safe they feel here. That’s something I really value in a job; to have clients feel like we care about them and not just because they’re paying for it. The knowledge that the staff has when it comes to individualizing the clients’ treatment plans and meeting the client where they are at is part of what sets Roots Through Recovery apart from other treatment facilities.

What kinds of changes have you seen in the industry since you began working with recovery facilities?
The thing that I think has changed the most is the growing acceptance of addiction as a mental health disorder and not just as a behavioral problem. It’s really opened up the doors for people with addiction problems to get the help that they need, because it’s so common for them to have a co-occurring mental health problem. The more knowledge that people have that it’s not just a behavioral problem but an underlying mental health issue can change the way that people look at addiction, which I think is really awesome.

How do you spend your free time when you’re not working?
I’m a big sports fan, and I think a lot of people know that. I’ll spend a lot of my free time watching sports, because I’m not very good at playing sports. It’s unfortunate because if I was, that’d probably be something I would want to do. Other than that, I love going to the beach, going to the movies, spending time with friends, playing video games, stuff like that.

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Holiday Blues: 3 Ways to Find Joy This Holiday Season

Holiday Blues: 3 Ways to Find Joy This Holiday Season

From what we see on TV and in movies, the holiday season seems to be filled with the fun and excitement of family get-togethers, food, gifts and festivities; but for the more than 55 million Americans who are struggling with addiction and mental health issues, the holidays may be something else entirely. The holiday season may actually seem traumatic. Holidays serve as reminders of what we don’t have, what we’ve lost, and what we wish we had.

Many people who are facing the challenge of addiction or mental health issues find the holiday season to trigger them, reminding them of past trauma, creating new trauma as we approach a holiday season without friends or family, or in uncomfortable situations with loved ones. These triggers can lead to symptoms of anxiety, depression and increased substance use. Whether you’ve thought about getting help for these issues or not, here are a few things you can do to increase happiness and avoid using substances this holiday season.

1. Practice Gratitude

Practicing gratitude — being grateful for what you do have – brings your attention and focus to the positive things in your life. The practice of gratitude has been proven to increase happiness, joy and compassion, while reducing feelings of depression, isolation and loneliness. To practice gratitude, you pick up a gratitude journal or start and end your day by writing down the things in your life that you’re grateful for.

2. Be Mindful

Much like practicing gratitude, mindfulness has been proven to have numerous positive effects on our overall well-being and leads to better health outcomes. Mindfulness brings our attention to the present moment, and out of the past and future, where regret and anxiety live. Practicing mindfulness for just 5 minutes a day has tremendous impact on your mental health, and can help alleviate the stress that often leads to using substances. Read more about mindfulness here

3. Create New Traditions

If you find your current holiday traditions are triggering for you, or you dwell on past traditions that once were, create new holiday traditions. If the way you’ve been doing things in the past haven’t worked, try something else. You can go for a hike, visit that place you’ve been wanting to go, volunteer at a homeless shelter or soup kitchen, or any number of other activities that have a positive impact on your well-being and help you practice steps 1 and 2, gratitude and mindfulness.

Please contact us if you need additional support or professional help. Call us at (562) 473-0827 or complete the form below.

 

WE ARE HERE TO HELP YOU

For immediate assistance, please call our Admissions Specialists at +1(562) 473-0827 or +1(866) 766-8776.

For more information or to start admissions – fill out the form below and we’ll reach out to you as soon as possible: